Kidney transplantation in sensitized recipients; a single center experience

• Published in: Journal of Korean medical science 2009, 24(0), , pp.143-147
• Main Authors: Kim, Sun Moon, Lee, Chungsik, Lee, Jung Pyo, Kim, Eun Man, Ha, Jongwon, Kim, Sang Joon, Park, Myoung Hee, Ahn, Curie, Kim, Yon Su
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal - pharmacology; Antibodies, Monoclonal, Murine-Derived; Antigens, CD20 - biosynthesis; Biopsy; Female; Graft Rejection; Graft Survival; Histocompatibility Testing - methods; Humans; Immunoglobulins - chemistry; Kidney Transplantation - methods; Male; Middle Aged; Original; Plasmapheresis; Rituximab; Transplantation Conditioning; 의학일반
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2009.24.S1.S143

A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long-standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.